Protracted speech development in cerebral palsy: Longitudinal insights and communication intervention implications

Speech production is a highly complex motor activity that relies on coordinated functioning of multiple body systems. In typical development, speech intelligibility continues to refine throughout middle childhood. With the introduction of functional classification systems for children with cerebral palsy (CP), researchers can describe abilities across multiple domains at different developmental stages, providing insight into how motor and communication skills may change. For example, Long et al.1 used the Viking Speech Scale (VSS)2 to track changes in speech impairment severity and intelligibility in children with CP aged 4 to 10 years. They found that almost half of the children (45%) showed improved speech intelligibility over the 6-year period. Building on Long et al.'s work, Jensen and Hustad3 examined both speech motor function (VSS) and gross motor function (Gross Motor Function Classification System) at ages 4 years and 14 years within the same cohort, offering a rare opportunity to compare developmental trajectories and examine relationships across two motor domains over a decade of growth. Their findings showed that, while gross motor function remained relatively stable, speech motor abilities continued to change for a substantial proportion of children into adolescence. Notably, some of the greatest improvements were observed among those with the most severe speech involvement at age 4 years. These results highlight the dynamic and prolonged nature of speech development in CP and reinforce the importance of maintaining high expectations for communicative growth, even for children who present with significant early challenges. Jensen and Hustad's findings align with the Participation Model,4 which emphasizes ongoing assessment of communication needs and opportunities to expand natural abilities. This model underscores the need for a holistic approach to developing communicative competence for participation, by optimizing natural communication modes, including speech, and supporting the use of augmentative and alternative communication (AAC). As children progress into adolescence, their communication demands increase across education, social, and community contexts, making flexible, multimodal, developmentally responsive intervention essential. The continued speech gains observed into adolescence in this study, suggest that children with CP benefit from sustained support for speech motor function while ensuring access to robust AAC systems to support broader expressive and receptive communication. Although this study offers valuable insights, the authors acknowledge several limitations. The small sample size limits generalizability and restricts the ability to examine diagnostic or medical factors that may influence speech severity outcomes. Larger longitudinal studies are needed to address these gaps and to investigate additional contributors to speech development, including the type and intensity of therapies that may support functional gains.1, 3 Future research could examine when VSS classifications stabilize1 and how changes in VSS levels relate to expressive communication function (Functional Communication Classification System),5 broader communication function (Communication Function Classification System), and real-world participation, supporting a more integrated understanding of communication in everyday life. Understanding these relationships would help determine when gains in speech performance meaningfully shift a child's primary expressive mode, how these changes interact with AAC use, and how best to tailor intervention to support participation across home, school, and community contexts. This is important because gains in speech motor function may not necessarily yield more effective communication or greater participation. Taking a more holistic approach to describing abilities at different developmental stages will better inform interventions that support the participation of children and adolescents with CP at home, in school, and in the community. Overall, Jensen and Hustad's work makes a substantial contribution to our understanding of long-term communication development in CP. It demonstrates that speech development follows a more protracted trajectory than gross motor development and highlights the importance of sustained, multimodal communication support throughout childhood and adolescence. Open access publishing facilitated by University of Southern Queensland, as part of the Wiley - University of Southern Queensland agreement via the Council of Australasian University Librarians. Not required.